- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.42 / $566.19
| Professional | | $30.00 | $42.42 | $566.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.77 / $364.77 / $809.10
| Professional | | $364.77 | $364.77 | $809.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.00 / $520.00 / $896.00
| Professional | | $320.00 | $520.00 | $896.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $540.00 / $616.67
| Professional | | $42.42 | $540.00 | $616.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $76.48
| Professional | | $50.00 | $60.00 | $76.48 |